Tuesday, May 17, 2016

I've been reading about the various flaws in the current assisted dying legislation, and my shower gave me an idea of a simple way to improve it, or any other assisted dying legislation really.

I propose that, in addition to whatever categories of patients legislators deem acceptable candidates for assisted dying, any patient who has tried everything and still wants to die is permitted access to assisted death.

I don't think this is anywhere near a whole solution, but I do think it's a (relatively) easy rule that is
unobjectionable to as many people as possible and achieves a number of things:

1. It catches the patients that legislators didn't think of. People generally want to impose restrictions on access to physician-assisted dying because they have various "What if?" scenarios in mind that they want to prevent, and they try to write restrictions that address those scenarios. But, apart from people who don't want anyone to die at all ever, I doubt any of the scenarios people are thinking of preventing include cases where absolutely everything has been tried and the patient still can't bear to go on living.

2. It could create an additional path to help patients access treatments they haven't been offered yet. Sometimes you hear about situations where doctors simply rule out the possibility of certain potential treatments on grounds that the patient might not agree with (e.g. to protect the patient's fertility). But if applying for physician-assisted dying triggers a review of what has been tried so far and a protocol for trying everything else, when they say "We can't offer you death without first trying to remove your ovaries to see if it helps," you can say "Great, let's do that!"

3. It provides hope for all patients. Even if you don't qualify for assisted dying right this second, you can get there just by following the standard protocol of trying, ruling out and refining treatments. It will take time and difficulty, but you can get there. Every unsuccessful treatment you attempt is a step towards being put out of your misery.

4. It provides a built-in waiting period. Many people who are opposed to death at will cite first-hand or third-hand experiences of wanting to die but then, after some time passes, not wanting to die any more. Their concern that the desire to die might go away with time would be addressed by all the time it takes to proceed through all the treatments, which makes them less likely to oppose this rule.

***

At this point, you're probably wondering about the definition of "everything". Does that mean you have to try every single medication in existence, or just a representative sample? Do you have to try alternative medicine? What if it's unproven? Do you have to participate in clinical trials?

And what if you can't afford the prescriptions or alternative medicine treatment? What if you can't get into the clinical trials?

First of all, I think the Try Everything rule could be implemented immediately before these points are addressed, with the understanding that we will take the time to examine the nuances and refine the definition of "everything". This will provide immediate access for a (admittedly very small) number of people who may have otherwise slipped through the cracks but whose death by choice is as unobjectionable as possible, because they already have tried everything and have documented evidence of this.

Then, the process of working on refining the definition of "everything" could leverage the Anti-Death No Matter What lobby to improve access to medical care in general. Currently, they seem to be limited to saying "No death! Death is Bad!" But this would give them positive things to lobby for that would serve as obstacles to death, but also help everyone in the meantime. For example, it's not reasonable to expect people to try every prescription medication if the cost is prohibitive. So now the anti-death lobby is incentivized to lobby for pharmacare. It's not reasonable to demand that people try alternative medicine that's unproven and not covered by OHIP, so now the anti-death lobby is incentivized to lobby for alternative medicine to undergo clinical testing, and for treatments that turn out to be proven by clinical testing to get covered by OHIP.

***

Of course, this comes nowhere near addressing all the problems with assisted dying legislation. Notably, it does nothing about the lack of ability to provide an advance directive. But, nevertheless, expanding assisted death availability to include patients who have tried everything would fill in some gaps while being consistent with the spirit and intent of the legislation.

Saturday, May 07, 2016

I recently received an email telling me that the drywallers' union is on strike, and this might cause delay to my condo. (Which isn't a problem - I'm perfectly comfortable in my apartment in the interim and I sincerely hope the people working so hard to build my home get a generous settlement that helps them be comfortable too.)

Googling around the idea, I get the impression that unions in the trades work like I recently learned unions in show business do - the union isn't specific to an employer, all workers who belong to a certain category are members of the union, and the different employers pay them according to the collective agreement for reasons I don't wholly understand but nevertheless am glad work.

Since they're going on strike, I assume they're in negotiations for a new collective agreement and the negotiations have stalled. (At least, this is the only situation I'm aware of that leads to a strike). Which raises a question I never thought about before: who's on the other side of the negotiating table?

The unions with which I'm personally familiar are all for the employees of a single employer. You work for that one employer, you're part of that union. You switch to another employer, you're no longer part of that union. So in collective agreement negotiations, the union is negotiating with/against the employer.

But since the drywallers and others like them (and the show business unions too) seem to represent everyone doing the same job for all different employers, who are they negotiating with/against? Is there someone who represents all the employers? A union of employers of unions?

Or is there a word for this kind of union where the workers work for many different employers, so I can google it better? (Non-employer-specific union was fruitless, and googling around the idea of multi-employer union kept getting interference from US health insurance plans. Also, I think Google's auto-complete feature is anti-union. But doing the same searches with DuckDuckGo just gives me even fewer Canadian results on the first page.)